Identification of Distinct Clinical Subphenotypes in Critically Ill Patients With COVID-19.
Identification of Distinct Clinical Subphenotypes in Critically Ill Patients With COVID-19.
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DOI：
10.1016/j.chest.2021.04.062
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发表时间：
2021-09
期刊：
影响因子：
9.6
通讯作者：
STOP-COVID Investigators
中科院分区：
文献类型：
--
作者：
Vasquez CR;Gupta S;Miano TA;Roche M;Hsu J;Yang W;Holena DN;Reilly JP;Schrauben SJ;Leaf DE;Shashaty MGS;STOP-COVID Investigators
在脓毒症和ARDS患者中已经发现了亚表型，并且与不同的结果和对治疗的反应相关。在COVID-19危重患者中能否确定独特的亚表型？我们使用了一项多中心队列研究的数据，该研究招募了来自美国67家医院的COVID-19危重患者，我们将中心随机分为发现队列和复制队列。我们在每个队列中独立使用潜在分类分析来确定基于临床和实验室变量的亚表型。然后，我们分析了亚表型与28天死亡率的关系。潜在分类分析确定了四种亚表型（SP），在发现（45个中心，n = 2188）和复制（22个中心，n = 1112）队列中具有一致的特征。SP1的特点是休克、酸血症和多器官功能障碍，包括肾替代疗法治疗的急性肾损伤。SP2的特点是c反应蛋白高，需要机械通气的时间早，ARDS发生率最高。SP3表现出最高的慢性疾病负担，而SP4表现出有限的慢性疾病负担和轻微的生理异常。发现队列的28天死亡率从20.6% （SP4）到52.9% （SP1）不等。在调整了人口统计学、合并症、器官功能障碍和疾病严重程度、地区和医院因素后，不同亚表型的死亡率仍然不同。与SP4比较，相对危险度如下：SP1, 1.67 (95% CI, 1.36-2.03)；Sp2, 1.39 (95% ci, 1.17-1.65)；SP3为1.39 （95% CI, 1.15-1.67）。在重复队列中发现相似。我们确定了COVID-19危重疾病的四种亚表型，它们具有不同的临床和实验室特征、合并症负担和死亡率模式。
Subphenotypes have been identified in patients with sepsis and ARDS and are associated with different outcomes and responses to therapies. Can unique subphenotypes be identified among critically ill patients with COVID-19? Using data from a multicenter cohort study that enrolled critically ill patients with COVID-19 from 67 hospitals across the United States, we randomly divided centers into discovery and replication cohorts. We used latent class analysis independently in each cohort to identify subphenotypes based on clinical and laboratory variables. We then analyzed the associations of subphenotypes with 28-day mortality. Latent class analysis identified four subphenotypes (SP) with consistent characteristics across the discovery (45 centers; n = 2,188) and replication (22 centers; n = 1,112) cohorts. SP1 was characterized by shock, acidemia, and multiorgan dysfunction, including acute kidney injury treated with renal replacement therapy. SP2 was characterized by high C-reactive protein, early need for mechanical ventilation, and the highest rate of ARDS. SP3 showed the highest burden of chronic diseases, whereas SP4 demonstrated limited chronic disease burden and mild physiologic abnormalities. Twenty-eight-day mortality in the discovery cohort ranged from 20.6% (SP4) to 52.9% (SP1). Mortality across subphenotypes remained different after adjustment for demographics, comorbidities, organ dysfunction and illness severity, regional and hospital factors. Compared with SP4, the relative risks were as follows: SP1, 1.67 (95% CI, 1.36-2.03); SP2, 1.39 (95% CI, 1.17-1.65); and SP3, 1.39 (95% CI, 1.15-1.67). Findings were similar in the replication cohort. We identified four subphenotypes of COVID-19 critical illness with distinct patterns of clinical and laboratory characteristics, comorbidity burden, and mortality.
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影响因子：
49.6
作者：
Bui, Anh L.;Horwich, Tamara B.;Fonarow, Gregg C.
通讯作者：
Fonarow, Gregg C.
影响因子：
76.2
作者：
Calfee, Carolyn S.;Delucchi, Kevin;Parsons, Polly E.;Thompson, B. Taylor;Ware, Lorraine B.;Matthay, Michael A.
通讯作者：
Matthay, Michael A.
DOI：
10.1164/rccm.201603-0645oc
发表时间：
2017-02-01
影响因子：
24.7
作者：
Famous, Katie R.;Delucchi, Kevin;Calfee, Carolyn S.
通讯作者：
Calfee, Carolyn S.
DOI：
10.1016/s2213-2600(19)30369-8
发表时间：
2020-03
期刊：
The Lancet. Respiratory medicine
影响因子：
--
作者：
Sinha P;Delucchi KL;McAuley DF;O'Kane CM;Matthay MA;Calfee CS
通讯作者：
Calfee CS
影响因子：
76.2
作者：
Scicluna, Brendon P.;van Vught, Lonneke A.;van der Poll, Tom
通讯作者：
van der Poll, Tom